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BY THE SAME AUTHOR. 



A PRACTICAL GUIDE TO THE STUDY OF THE DIS- 
EASES OF THE EYE. New Edition. With Illustrations. 
1 vol. 12ma. $3.00. 

RECENT ADVANCES IN OPHTHALMIC SCIENCE. 1 vol. 
12mo. Paper, 50 cents ; cloth, $1.00. 

Published by 

JAMES R. OSGOOD & CO., 

124 Tremont Street, Boston. 



c.pl/2..fi' 

OUR EYES, 



How to Take Care of Them. 



J 



BY 



HENRY W. WILLIAMS, A.M., M.D., 

PRESIDENT OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY, LEC- 
TURER ON OPHTHALMOLOGY IN HARVARD UNIVERSITY, OPHTHAL- 
MIC SURGEON TO THE CITY HOSPITAL OF BOSTON, FELLOW 
OF THE AMERICAN ACADEMY OF ARTS AND SCIENCES, 
FELLOW OF THE MASSACHUSETTS MEDICAL SOCIETY, 
HONORARY FELLOW OF THE RHODE-ISLAND 
MEDICAL SOCIETY, ETC., ETC. 









BOSTON: 
JAMES R. OSGOOD & CO., 

(LATE TICKNOR & FIELDS, AND FIELDS, OSGOOD, & CO.) 
l87T. ' 






Entered, according to Act of Congress, in the year 1871, 

By HENRY W. WILLIAMS, 

In the Office of the Librarian of Congress, at Washington. 



Boston : 
Stereotyped and Printed by Rand, A very, &> Frye, 



PEE FACE. 



The Author's purpose in preparing 
these papers, first published in " The 
Atlantic Monthly/' was to explain to 
parents, teachers, and. all who have oc- 
casion to use their eyes, in the simplest 
language possible, some of the advances 
which have been recently made in our 
knowledge of the eye, its powers, and 
its proper uses; and to show what 
should be done and what avoided, that 
the sight, the most important of our 
senses, may be enjoyed and preserved. 



PREFACE. 

Furthermore, he has endeavored to 
point out some of the dangers to which 
the eye is exposed, in the hope that 
those arising from disease may thus be 
lessened, and those due to ignorance 
and neglect averted. 

15 Arlington Street, Boston, 
April, 1871. 



OUR EYES, AND HOW TO TAKE 
CARE OF THEM. 



THE form of the eye, its structure, and 
its powers, .call forth fresh admiration 
as they successively claim our attention. Its 
form affords the greatest resistance to external 
violence, and is most perfectly adapted for 
the fulfilment of the function of vision, as it 
allows of the continued exercise of its powers 
during the act of turning the eye, which 
could have been accomplished in no other 
way. Had its shape been different, it would 
have been less strong, unless made up of 
heavier materials ; and its glance could not, 
as now, have strayed at will " from heaven to 
earth, from earth to heaven," reading, near 
and far, the ever-present lessons of light and 
beauty. 7 



8 OUR EYES: 

Even bone would have been a less perfect 
protection for the delicate internal parts than 
is the light tissue which forms the framework 
of the globe, — so yielding in its elasticity, yet 
so firm in its tough resistance. In front, we 
find the strong white membrane, the sclera, 
modified to a transparent structure, the cor- 
nea, an equal safeguard against intruding 
enemies, and giving unimpeded entrance to 
light alone. 

The nerves and blood-vessels, which, if 
placed in it, would have weakened the fibrous 
envelope, are included in another interior 
membrane, the choroid ; and within these is 
spread out the delicate nervous perceptive 
tissue, the retina, to which all the other parts 
are auxiliary and subservient. Upon this 
images of all visible Nature are pictured : 
from it the fleeting impressions are tele- 
graphed to the brain, and we are conscious 
that we see. 

But, to this function of seeing, other condi- 
tions are essential. The eyeball, the most 



HOW TO TAKE CARE OF THEM. 9 

perfect of optical instruments, must have its 
focal powers completed by the presence of 
refracting substances, the aqueous and vitre- 
ous humors and crystalline lens, which at the 
same time give form to the globe, and by 
their quiet pressure keep the nervous tissue 
expanded, and in readiness for its appropriate 
work. By a combination of these refracting 
agents, the rays emanating from objects are 
transmitted and concentrated so as to render 
the image upon the retina distinGt and well 
defined. 

Furthermore, the passage of rays through 
these transparent media is regulated by a cur- 
tain, the iris, of which the circular opening, 
the pupil, expands and contracts according to 
the amount of light ; the movements of the 
curtain being self -impelled, without any effort 
of the will. Thus, contracting in a strong 
light, it protects the retina from being injured 
by the glare ; and, expanding where the light 
is dim, it allows a larger number of rays to 
enter, so as to form a clear image. Like the 



10 OUR EYES: 

choroid, this curtain is lined with dark color- 
ing-matter, not only to absorb any irregularly 
refracted rays, and prevent reflections from 
side to side within the globe, but to exclude 
the entrance of light through the coats of the 
eye, except in the direction most suitable for 
refraction, — through the cornea and pupil. 

To complete the noble endowment of ca- 
pacities, the eye has yet another power. It 
is a self-regulating optical instrument. We 
may turn ©ur eyes from the printed page to 
gaze at a distance, or withdraw them from 
space to fix them upon a minute atom ; and 
the eye adapts itself instantly to each of these 
uses. By means of a circle of delicate fibres, 
so small that till lately their existence and 
uses were unknown, — the ciliary muscle, — 
the. convexity of the crystalline lens can be 
increased, and its focal power varied; and 
thus, without conscious effort, the eye may 
contemplate the glories of the firmament, or 
catch the first flitting expression of an infant's 
love, or explore the mysteries of microscopic 
existences. 



HOW TO TAKE CARE OF THEM. 11 

Finally, we have two eyes ; not merely 
that we may be doubly provided against the 
danger of accidental loss of the inestimable 
privileges of vision, but to enable us to esti- 
mate the size, form, and distance of objects 
with more correctness than we could with one 
eye alone. To a single eye, every thing would 
have appeared as a plane surface ; and it would 
have been difficult to determine whether ob- 
jects had solid or only superficial dimensions, 
or whether they were near or far. With two 
eyes, the impressions made on each mutually 
correct one another, and combine to convey 
to the brain perceptions of the properties of 
things which could otherwise have been 
gained by the touch alone. 

HOW TO USE THE EYES. 

Every normal eye is capable of a great 
variety and amount of use. It sees near or 
far with the same ease and with equal clear- 
ness. But these powers, extensive as they 
are, may be overtasked. Because the eyes 



12 OUR EYES: 

can see minute objects without difficulty, it 
does not follow that they should be kept al- 
most constantly looking at small objects. 
They were intended for varying use ; and, like 
any other organ of the body, they may be 
enfeebled or injured by having their most 
delicate powers continually and exclusively 
emploj^ed in one manner. 

One of the first rules laid down by a 
teacher to his pupils should be, not to keep 
their eyes fixed upon their books. Apart 
from the probable injury to the eye itself by 
too close application, I am satisfied that les- 
sons, especially those requiring thought, can- 
not be as well committed to memory when the 
eyes are fixed upon the page as if they are 
permitted to wander. The eyes must, of 
course, look at the book often and long 
enough to take in the idea ; but, if they are 
too steadily kept there, the perceptive power 
seems to occupy itself with the visible objects 
to an extent which is unfavorable to other 
mental processes. A distinguished engraver 



110 W TO TAKE CARE OF THEM. 13 

once said to me, " I know now how to make 
a face think ; " and he explained that the 
secret lay in giving a certain expression to the 
eyes by causing their axes to have a very 
slight divergence from each other. This cor- 
responds with my observation ; and this posi- 
tion of thought is exactly the opposite of that 
assumed by the eyes when looking at a book. 
For the sake of even normal eyes, it would 
be most desirable that education should be 
simplified; that children should not be re- 
quired to learn an infinity of details which 
they are sure to forget, and which could be 
. of no possible use to them if retained ; that 
they should be taught to think as well as to 
remember, — and, in fact, as a means of re- 
membering, — instead of giving all their time 
in school, and often out of school, and by ar- 
tificial light, to acquiring a parrot-like facility 
of repeating lessons which they do not com- 
prehend. It might require more pains, but 
it would certainly be a great advantage, if 
teachers would teach children what they know, 



14 OUR EYES: 

rather than content themselves with being" 
mere hearers of lessons which may have been 
learned by the eye, but often not by the un- 
derstanding. 

It would scarcely seem to be necessary to 
say a word of warning in regard to impru- 
dent testing of the power of the eyes ; but 
instances are not rare where children or adults 
have done their eyes serious harm by trying 
to look at the sun, or by observing an eclipse 
without using a smoked glass. The direct 
solar light and heat seems, in these cases, to 
destroy the perceptive power in a greater or 
less portion of the retina. Injury may also 
result from using the eyes for looking at small 
objects by moonlight, which does not give 
sufficient illumination for such purposes. 

SOME POPULAR ERRORS. 

There comes a time when normal eyes find 
their powers grown limited, and require more 
light, or assistance from glasses, when look- 
ing at small near objects. When this period 



110 W TO TAKE CARE OF THEM. 15 

arrives, it is an error to persist in endeavors 
to do as formerly with the eyes ; but much 
use must be avoided, except in a clear light 
or with the required auxiliaries. It is also a 
mistake, as will hereafter be shown, to sup- 
pose that glasses should not be worn while it 
is possible to avoid doing so : on the con- 
trary, they serve to prevent straining of the 
^eyes, and preserve rather than injure vision. 
Certain defects of refractive power are due 
to maleformation of the eye, either existing 
from birth or acquired afterwards, and are 
not to be removed by remedies or by manipu- 
lation. It is a mischievous error to suppose 
that the form of an elastic globe, filled with 
fluid or semi-fluid substances, can be changed, 
except for the moment, by pressing upon it 
with the fingers, as has been recommended 
by charlatans. All the theories, that the eye 
can have its form favorably modified by rub- 
bing it alwaj^s in one direction, or by any 
other manipulation, have no foundation in 
facts. But while persistent squeezing, ac- 



16 * OUR EYES: 

cording to these methods, can never do any 
permanent good, it involves great risks. It 
may lead to congestion and hemorrhage within 
the eyes ; or give rise to destructive inflam- 
mation or the formation of cataract by dislo- 
cating the crystalline lens ; or cause almost 
immediate loss of sight by separation of the 
retina from its neighboring parts ; or may in- 
crease the giving way of the back part of the 
globe, which is already often begun in near- 
sighted eyes. 

The same warnings will apply with equal 
force against the use of the eye-cups fitted 
with rubber bulbs, to alter the form of the 
eyeball, as is asserted, by suction. Valueless 
and dangerous as they are, persons are often 
persuaded to purchase and try them, — some- 
times to their sorrow. 

VARIATIONS FROM THE NORMAL STANDARD 
OF SIGHT. 

Every eye ought to see distant objects 
clearly. If it cannot do so, its refractive 



HOW TO TAKE CARE OF THEM. 17 

power is at fault, or it is the subject of disease. 
The eye ought also to have clear perception 
of small objects, such as print, &c, when 
held at a proper distance. If it has not, the 
fault may lie in either the refractive power 
or the accommodative function ; or there may 
be disease of some of its parts. 

NEAR-S T GHTEDNESS. 

Myopia, or " near-sight," is by-far the most 
important, as it is also one of the most com- 
mon, of the refractive defects of the eye. In 
the other forms of abnormal refraction we 
have merely a defect of construction, giving 
rise, it is true, to annoying disabilities, but 
having no tendency to further changes of 
structure or function. Near-sightedness, on 
the contrary, where it exists in a high degree, 
is not simply an infirmity, as is usually sup- 
posed, but is, in many cases, associated with 
grave disease of the posterior parts of the 
eyeball, having progressive tendencies, and 
not seldom resulting in loss of all useful 



18 OUR EYES' 

vision. It has, furthermore, a strong disposi- 
tion to hereditary descent, re-appearing in the 
children or grandchildren of myopes. 

The defect in form, in short-sighted eyes, 
does not consist, as was formerly supposed, 
in an undue prominence of the front part of 
the eye, but in an elongation of the whole 
globe from before backwards ; so that it 
assumes an olive or egg shape, instead of 
being round. This lengthening mostly occurs 
at the back part of the eyeball, and is not 
to be observed at first sight ; but, in many 
cases, we may see that the eye has this altered 
form, and extends back farther than usual in 
the socket, by drawing the lids apart at the 
side next the temple, the eye being at the 
same time turned towards the nose. 

All the coats of the eye are implicated in 
these changes, which take place, sometimes 
by gradual expansion at every point, but 
usually by a more considerable giving way 
around the entrance of the optic nerve. In 
examination of such eyes after death, a posi- 



HOW TO TAKE CARE OF THEM. 19 

tive bulging of the sclera is seen at this 
point. During life, Ave can observe these 
changes, and watch their progress, by means 
of the ophthalmoscope. This instrument, 
by which we are enabled to illuminate and 
explore the interior of the eye, has thrown 
new light upon the whole subject of near- 
sightedness. By its aid we are able to follow 
the morbid changes as they are successively 
developed. We can distinctly observe the 
progressive giving way of the retina, optic 
nerve, choroid, and sclera, to form the bulging 
which is termed posterior staphyloma; can 
notice the congestion and other changes fol- 
lowing imprudence ; and, too often, can see 
the advent of separation of the retina from 
the choroid, with its accompanying loss of 
sight. 

As the retina expands with the general 
enlargement, the nerve tissue, in that layer 
of the retina which is the seat of its especial 
function, is, of course, extended over a larger 
surface, and its perceptive power proportion- 



20 OUR EYES: 

ally weakened. Many such eyes are therefore 
unable to see distant objects with normal 
clearness, even with the glasses which most 
completely correct their myopia, although 
they see small near things perfectly well. It 
seems to be necessary that a larger number 
of rays should fall upon a given area of the 
retina in order to produce a distinct impres- 
sion. This lack of acuteness of vision is often 
much greater in the evening ; so that persons 
thus affected cannot then see to drive a horse 
safely, or distinguish the outlines of objects. 
Eyes which are but slightly myopic often 
see nearly as well as others, at a distance, by 
the aid of suitable glasses ; and they have 
almost microscopic vision of near objects, and 
can read in a dim light. These facts have 
given rise to the popular belief that near- 
sighted eyes are stronger than others, and 
able to bear every kind of use and abuse ; 
and the delusion is encouraged by the dispo- 
sition shown by myopic persons to choose 
occupations requiring close sight, and by 



HOW TO TAKE CARE OF THEM. 21 

their ability to read at an advanced period 
of life without glasses. This belief would 
be well founded but for the tendency to the 
gradual changes already described. 

The progress of the alterations in the pos- 
terior parts of the eye is favored by the 
stooping position of the head, which allows 
the blood to accumulate in the vessels of the 
eyeball, and by too-long continued use of the 
eyes upon minute objects, which requires 
such action of the external fnuscles that the 
globe is compressed from side to side, and is 
thus made to yield still further at that part 
where the already thinned tissues offer but 
slight resistance. With each degree of 
change, the process becomes easier ; the eye- 
ball grows misshaped, to a degree which limits 
its motions in the socket ; and the eye most 
affected no longer acts with its fellow, but is 
disposed to turn outwards, and to give up 
attempts at vision. 

With increased implication of the retina in 
the morbid changes, its perceptive acuteness is 



22 OUR EYES: 

more or less reduced, especially as regards 
distant objects ; and glasses no longer give 
them the same clear outlines. 

The morbid processes may be arrested at 
the early stages of their development ; and, 
by good fortune and prudent management, the 
eyes may retain through life nearly the nor- 
mal powers ; or, if even considerable changes 
have taken place, these may remain station- 
ary, and give rise to little inconvenience : 
but if they are not recognized, and means 
taken to avert their progress, they may go on 
till the retina becomes useless, being separated 
from the choroid by fluid which collects be- 
tween these membranes. 

The changes I have described are insidious 
in their course. Slight warnings are some- 
times felt; but, as a rule, the eyes, unless 
examined with the ophthalmoscope, exhibit 
and feel no symptoms calculated to excite 
alarm, except, perhaps, an increase of the 
myopia, which frequently, but not invariably, 
occurs, often unnoticed by its subject. After 



HOW TO TAKE CARE OF THEM. 23 

reaching a certain degree, there is little hope 
that further changes will be averted by any 
care or skill. The conditions have become so 
unfavorable, that the morbid tendencies can 
no longer be successfully opposed ; and each 
year sees a downward progress. Even where 
the staphylomatous enlargement has not been 
excessive, separation of the retina will some- 
times suddenly occur. I have repeatedly 
seen cases where this had taken place within 
a single twenty-four hours after some unusual 
exertion of the eyes, and where blindness was 
already nearly complete. 

It is quite time that the attention of the 
community was drawn to a matter of so much 
importance. At least in some classes of so- 
ciety, the possibility of blindness at or near 
middle life from changes incident to excessive 
near-sightedness, as well as the predisposition 
to transmit the same infirmities and liabilities, 
ought to be taken into account in forming 
matrimonial alliances, like any other impend- 
ing disability from incurable ailment. The 



-4 OUR EYES: 

fact of its being frequently inherited once 
understood, parents should watch for any 
early manifestations of its presence in their 
children, and take measures to prevent 
its progressive increase. Teachers should 
impose upon myopic eyes as little as possible 
of studies requiring close application, even 
though, at the time, the child makes no com- 
plaint. It is questionable if our system of 
education, augmenting* as it does the fre- 
quency and degree of near-sightedness, is 
an advance in civilization. It would be 
better to go back at once to the oral teach- 
ings of the schools of Athens than to go on 
creating our favorite type of educated men 
and women at the expense of their own and 
their children's eyesight. 

No medical skill can bring back these del- 
icate tissues, once distended, to their former 
healthy condition ; or even, in some cases, 
prevent the steady onward march of the dis- 
ease. But prevention is, in a measure, within 
our power. Myopic eyes should not be used 



HOW TO TAKE CARE OF THEM. 25 

continuously for small objects, and especially 
witli the head bent forward ; fine and bad 
print should be a fatal objection to a school- 
book ; the use of lexicons, or close mathemat- 
ical work, should be limited and interrupted ; 
written exercises should be almost dispensed 
with ; and the child should be spared search 
upon the map for unimportant places. The 
book should be held up when possible ; and 
the pupil should not keep his head leaned 
over his desk, nor be allowed to study by a 
feeble light. 

If by these precautions the child reaches 
adult 'age without any considerable develop- 
ment of his myopia, he will thenceforth be 
comparatively safe, as changes are less likely 
to occur after this period. But if, from 
thoughtless mismanagement, large and pro- 
gressive structural alterations of his eyes have 
been brought on during his years of study, 
he may not # only find himself disabled from 
pursuing ^uch other occupations as he may 
desire, but may be in a condition foreboding 
further misfortune. 



26 OUR EYES: 

Except when slight, myopia lessens little, 
if at all, with age ; but it sometimes happens 
with those who are only a little near-sighted, 
that, while still requiring concave glasses for 
clear vision of distant objects, they will, after 
middle life, also need convex glasses for read- 
ing. 

There are a few cases of apparent myopia 
where this does not really exist ; as some- 
times in children or aged persons affected 
with cataract, or where ulceration or other 
disease has existed. But it is sufficient here 
to refer to these as possible, without attempt- 
ing their description. 

• The axis being too long in nr^opic eyes, 
parallel rays, such as proceed from distant 
objects, are brought to a focus at a point so 
far in front of the retina, that only confused 
images are formed upon it. Such a male- 
formation, constituting an excess of refractive 
power, can only be neutralized by concave 
glasses, which give such a direction to rays 
entering the eye as will allow of their being 



HOW TO TAKE CARE OF Til EM. 27 

brought to a focus at the proper point for 
distinct perception. It is, therefore, irra- 
tional and useless to attempt a substitution 
of other means, instead of resorting to these 
glasses, which, by rendering parallel rays di- 
vergent, adapt them for the excessive refrac- 
tion of the myopic eye, thus relieving an 
infirmity which is not to be removed. 

The use of glasses for distant vision is often 
objected to by parents and friends, from an 
idea that the short-sightedness will thus be 
increased, or in the expectation that the eyes 
will become of normal power at a later period 
if glasses are not worn. Both of these opin- 
ions are erroneous. Myopic eyes are not 
injured by wearing suitable glasses ; but, on 
the contrary, are often preserved from injuri- 
ous pressure on the globe in the indulgence 
of the habit of nearly closing the lids in order 
to obtain a clearer impression of the images 
of distant objects, as is commonly done when 
glasses are not worn. Nor will the myopia 
be appreciably lessened by abstinence from 



28 OUR EYES: 

glasses. It is best, therefore, not to deprive 
young people of the many pleasures arising 
from distinct vision of things around them, in 
the illusive hope that the great sacrifice thus 
made will be compensated by any benefit. 

Such glasses should be selected as make 
distant objects clear without lessening their 
size and giving them an unnatural brilliancy. 
If no glass gives this clearness, the acuteness 
of perception may have already become im- 
paired, or there may be a complication of the 
myopia with astigmatism. Many myopes use 
the same glasses for reading or music which 
they wear for distant vision. It is best, how- 
ever, when the myopia is but slight, to dis- 
pense with these in reading, sewing, &c. ; or 
to wear a lo^er number, such as will allow 
of distinct sight at the distance where the 
book or music would ordinarily be placed. 

HYPEROPIA, OR OVER-SIGHT. 

The condition termed hyperopia is the 
opposite of short-sightedness, and consists in 



HOW TO TAKE CARE OF THEM. 29 

abnormal flatness of the eyeball from before 
backwards, with, in some cases, a positive 
smallness of the globe in all its dimensions. 
This maleformation may be seen at the outer 
extremity of the orbit by separating the lids 
while the eye is turned towards the nose, 
the eyeball having somewhat the shape of a 
turnip. 

The antero-posterior axis of such eyes being 
too short, their refractive power is not suffi- 
cient to bring even parallel rays to a focus 
upon the retina, but is adapted for convergent 
rays only. It is therefore evident that con- 
vex glasses, which, by rendering parallel rays 
convergent, compensate for this deficient re- 
fractive power, must be the only effectual 
means of relief. This condition is not to be 
confounded with old-sight, where the refrac- 
tive power is perfect, and distant vision good. 

Where the hyperopia is of moderate de- 
gree, the exercise of the accommodative func- 
tion in aid of the refraction is sufficient to 
give clear vision of distant objects, and even 



30 OUR EYES: 

for reading during childhcfod and youth. But 
glasses will be required for reading at an 
earlier age than they are needed by normal 
eyes ; and, in the mean time, such eyes should 
be carefully used, and never employed for a 
long time upon small objects, especially in a 
feeble or artificial light. When the hj'peropia 
is of greater amount, almost any continuous 
use of the eyes is painful, and convex glasses 
are indispensable, even sometimes from the 
age of six or seven years. 

This imperfection of the eye is often unde- 
tected for a, considerable time, during which 
a child thus affected experiences great annoy- 
ance, and gets very little sympathy. The 
child is able, as a general rule, to see at a 
distance ; and perhaps, by using nearly all his 
accommodative power, obtains even clear im- 
ages of large objects. But if, on a dark day, 
or when confused by the presence of stran- 
gers, he is asked to read a fine or blurred 
print, his sight soon becomes confused, and 
he ceases to distinguish the words. He stam- 



HOW TO TAKE CARE OF THEM. 31 

mers and hesitates. His parent or teacher, 
knowing that he has read the same lesson 
well enough at other times, thinks him stupid 
or wilful ; and reproaches or punishments are 
perhaps administered, which, by disturbing 
the nervous sj^stem, lessen yet more his power 
of accommodation, and increase his visual in- 
ability. The child is himself at a loss to un- 
derstand why he cannot then see what he 
knows he has seen. 

It is, perhaps, accidentally noticed that such 
a child sees well with his grandmamma's spec- 
tacles : but this discovery is often only re- 
ceived with an outcry of astonishment ; the 
glasses are snatched off; and he is denied this 
assistance, the only means which can be of 
real use to him. 

Instances are now and then met with where 
glasses are even more necessary at six or 
eight years of age than they are to the ma- 
jority of healthy eyes at sixty years. But 
this extreme hyperopia is less frequent than 
moderate degrees of this imperfection occur- 



32 * OUR EYES: 

ring in youths and young adults. These have 
been able to use their eyes during childhood 
with little difficulty by making constant use 
of their accommodative power ; but, as this 
begins to lessen from the age of ten years, 
they at length observe symptoms of what is 
termed asthenopia, or weak sight, and feel 
pain in the eyes, or above the brows, after 
long-continued use. 

As is well known, convex glasses have the 
property of bringing parallel rays to a focus 
at a distance from the glass corresponding to 
its degree of curvature. Thus they assist 
hyperopic eyes by rendering rays so far con- 
vergent before they enter, that, even with its 
deficient refractive power, the eye is able to 
form a distinct image on the retina without 
any further exercise of its accommodative 
faculty than is required in a normal eye. It 
is evident that such glasses are the only ra- 
tional and efficient means of relief for hyper- 
opic persons. They may be worn both for 
distant and near vision, enabling the eyes to 



HOW TO TAKE CARE OF THEM. 33 

refract parallel rays sufficiently while keeping 
the accommodative power in reserve, as in 
the normal eye, for the concentration of the 
divergent rays which proceed from small near 
objects. 

The glasses should be such as afford the 
clearest and most comfortable vision : but it 
is often necessary to wear at first a weaker 
number than is subsequently needed, or than 
will entirely neutralize the hyperopia; be- 
cause the eyes have been so long accustomed 
to exert their accommodative power for all 
purposes, that it is difficult at once to relax 
this effort when looking at distant things, 
although the glasses supersede the necessity 
for it. 

SQUINTING AS A CONSEQUENCE OF HYPEROPIA. 

It was first shown by Professor Donders of 
Utrecht, that nearly all the cases of squinting 
towards the nose, " cross-eyes " as they are 
sometimes termed, are accompanied by and 
result from hyperopia. This convergent stra- 



34 OUR EYES: 

bisnius, or squint, is caused by excessive use 
of the muscles which turn the eyes inwards, 
in the endeavor, by increase of the accommo- 
dative effort, to obtain distinct vision. 

It is very important that this defect should 
be remedied in early childhood, as, if allowed 
to continue, vision frequently becomes so much 
impaired in the eye which is most deviated, 
that it is not regained after an operation per- 
formed at a later period. When occurring 
later in life, where glasses can be intelligently 
used to correct the hyperopia, the strabismus 
may be relieved by this means. Glasses are 
often required, after an operation, to increase 
and maintain its good results ; but, in matters 
so important, competent advice should be ob- 
tained, without heeding the counsel of friends 
who advise delay. 

ASTIGMATISM. 

Astigmatism usually depends on a difference 
of curvature in two meridians of the cornea; so 
that rays passing through one meridian are 



HOW TO TAKE CARE' OF THEM. 35 

brought to a focus sooner than those passing 
through a plane at right angles to the first. 

Persons having this defect of refraction 
sometimes observe that they see certain lines 
more clearly than others : vertical lines, for 
instance, will appear well defined, while those 
which are horizontal are indistinct, or vice versa. 
In many cases, however, their attention has not 
been directed to these phenomena ; but they 
are only conscious that they see with difficulty 
and pain if the eyes are much used. In some 
instances, they have tried convex or concave 
glasses with little benefit. Frequently so 
much irritation and congestion of the eyes 
has been induced, that these symptoms are at 
first supposed to constitute the disease, the 
primary affection being overlooked. 

Astigmatism may be present in an eye oth- 
erwise normal, or may co-exist with hyperopia 
or myopia. Its degree, or its meridians of 
greatest variation, may be different in the two 
eyes ; which should, therefore, be separately 
tested. It can only be relieved by glasses 



36 • OUR EYES: 

ground upon cylindrical instead of spherical 
surfaces, so as to refract rays passing through 
one meridian, while those at right angles to it 
are unaffected. The glasses must be accu- 
rately fitted, and their frames carefully adapt- 
ed to the eyes, as any deviation of the axis 
of the cylindrical glass from its proper direc- 
tion with regard to the faulty meridian of the 
cornea lessens, or even nullifies, its corrective 
power. 

Immense relief is often found in wearing 
these glasses ; and unbounded gratification is 
sometimes expressed by those who, after many 
fruitless endeavors, see by their aid for the 
first time with real distinctness. 

Convex-cylindrical and concave-cylindrical 
glasses are now kept for sale by many opti- 
cians ; and, where other glasses fail to give re- 
lief, the eyes should be tested with parallel 
vertical and horizontal lines. The selection 
of cylindrical glasses is, however, often a ques- 
tion involving nice adaptation to complicated 
conditions of refraction ; and, in the mixed 



HOW TO TAKE CARE OF THEM. 37 

and compound forms of astigmatism, it is some- 
times necessary to have glasses ground of dif- 
ferent curvatures upon their two surfaces to 
suit each case. 

ACCOMMODATION OF THE EYE. 

Thus far we have considered the eye as an 
organ possessing refractive powers only ; but 
it has other capabilities as an optical instru- 
ment in its admirable power of self-regulation, 
by which it is able to adapt itself spontaneous- 
ly for seeing distant or near objects. This is 
termed the faculty of accommodation. 

In looking at distant objects, the normal eye 
is in a state of rest; and the parallel rays 
which enter it from such objects are brought 
to a focus, so as to form a distinct image upon 
the retina, by the refractive power alone, 
without calling into play the accommodative 
function. 

Rays proceeding from near objects are no 
longer parallel, but diverge from each other, 
and require an increased focal power for their 



38 OUR EYES: 

concentration to form a clear retinal image. 
This increased power is supplied by accommo- 
dation. 

Accommodation of the eye for vision of near 
objects is obtained by two distinct but inti- 
mately associated muscular efforts. The eye- 
balls are turned towards each other by the 
internal recti-muscles, so that the diverging 
rays may enter each eye in the direction of 
its axis, and not obliquely ; and at the same 
time the ciliary muscle, within the eye, acts 
upon the crystalline lens, and increases its con- 
vexity, augmenting, in so doing, its refractive 
power, and thus giving to the divergent rays 
the same direction towards the retina as if 
they had entered the eye as parallel rays. 

The accommodative power may be weak- 
ened or lost from various causes. 

OLD-SIGHT. 

To many persons, the discovery that they do 
not see as well as they once did is the first 
intimation of receding youth. Infirmities, 



I10W TO TAKE CARE OF THEM. 39 

wrinkles, tliey may have none ; but they sud- 
denly become aware that they sometimes can- 
not thread a needle or read fine print without 
fatiguing effort. 

At first, such a person finds that he can 
still read any print by placing the book farther 
from his eyes, thus rendering the rays less di- 
vergent, or by holding it near a light, so as to 
obtain a better illumination of the page, and 
thus increase the number of luminous rays 
which enter the eye. At length, however, he 
finds that neither holding the book at arm's- 
length, nor going nearer the light, will give 
him his accustomed vision, especially in the 
evening or on a cloudy afternoon. Fine print 
appears blurred ; and, if read at all, it is slow- 
ly and with difficulty. If he writes in the 
evening, he perceives the next day that he 
has written larger than his ordinary hand. 

Meanwhile, perception of distant objects is 
as clear as ever ; and many an individual, puz- 
zled to account for the loss of his former 
minute vision, struggles in vain to continue 



40 OUR EYES: 

some of his favorite pursuits and to read his 
evening newspaper comfortably, until, per- 
haps, he tries on a convex glass, and his re- 
joicing eyes at once regain all their faculties. 

One of the parts principally concerned in 
accommodation, the crystalline lens, gradu- 
ally increases in hardness ; and, in most eyes 
of previously normal accommodation, this 
hardness attains such a degree at about forty- 
five years of age, that the ciliary muscle can 
no longer effect the change of form in the 
lens which is requisite for the concentration 
of divergent rays ; or, if this can be done for 
a short time, the eye soon becomes conscious 
of a fatiguing effort, and is forced to abandon 
it. This state of things is presbyopia, or old- 
sight. 

It is evident from this explanation of the 
changes in the lens, that a suitable convex 
glass, which lessens the divergence of the 
rays before they enter the eye, and thus calls 
for less effort of accommodation, must be the 
sole means of relief. 



HOW TO TAKE CARE OF THEM. 41 

The advice often given to those who begin 
to experience symptoms of presbyopia, to put 
off the use of glasses as long as possible, is 
injudicious ; and the assertion, that persons 
who decline to use glasses for a certain time 
will be able always thereafter to dispense 
with them, is wholly erroneous so far as re- 
gards normal eyes. It is generally made by 
those who are themselves short-sighted, and 
for that reason are able to see small objects 
without glasses at and after the age when 
others require their assistance. 

But the use of convex glasses may be post- 
poned for a while, without injury to the eyes, 
in deference to the reasonable wish of a lady 
to appear young as long as possible, or from 
any motives of convenience or preference ; 
provided the eyes are used but sparingly for 
small objects, especially when the light is 
dim. 

Such glasses should be chosen as render 
objects clear without much enlarging them. 
At first, they may be needed only in the even- 



42 OUR EYES: 

ing or on a cloudy day ; but, as each year 
lessens the accommodative ability of the eye, 
it follows that glasses will be more and more 
constantly required. After a time, their focus 
must be increased, because of the renewal of 
the original symptoms ; the lens having un- 
dergone yet further hardening, and become 
less capable of accommodative change. 

LOSS OF ACCOMMODATION AFTER ILLNESS. 

After certain diseases, among which diph- 
theria, measles, and scarlatina may be espe- 
cially mentioned, the accommodative power 
is often partially or almost wholly lost. In 
diphtheria, this loss of power in the nerves 
supplying the ciliary muscle is often associ- 
ated with partial and temporary paralysis of 
some other nerves, particularly those of the 
throat. For the time being, the person is 
more or less unable to see small objects, to 
continue reading, &c. But, although the re- 
covery of these delicate nervous functions is 
often gradual, they may be restored by appro- 



HOW TO TAKE CARE OF THEM. 43 

priate treatment as the system gains strength. 
Every care should be taken to avoid prostra- 
tion of the nervous system ; and the eyes 
must be sparingly used until they regain the 
ability to work without fatiguing effort. 

INSUFFICIENCY OF THE INTERNAL RECTI 
MUSCLES. 

Besides the change of form in the lens, we 
have also, in accommodation for near objects, 
a convergence or turning of the eyes towards 
each other. This is effected by the action of 
the internal recti muscles, which turn the 
eyeballs inwards towards the nose. Rays 
from an object thus enter the two eyes in 
such a direction as to fall upon corresponding 
portions of their retinae, and form there 
images which harmonize with each other. If 
these converging muscles act too feebly, al- 
though the accommodation may be good as 
regards either eye when used alone, the 
other eye being covered, there will be a want 
of harmony in the images formed in the two 



44 OUR EYES: 

eyes when used together, so that a confused 
impression will be conveyed to the brain. 
The efforts made by the enfeebled muscles to 
maintain their accustomed action cause a 
feeling as of strain at the inner side of the 
eyeball, near the insertion of the muscles, the 
discomfort often extending to the forehead 
above the eyes. 

Continuous use of the eyes, when insuffi- 
ciency is present, brings on a sensation simi- 
lar to that experienced when any other mus- 
cle is kept too long upon the stretch ; as, for 
instance, when the arm holds up a heavy 
•weight. Frequent intervals of rest should 
therefore be allowed such eyes. 

A disposition to turn outwards is often ob- 
served in very near-sighted eyes, but is then 
generally associated with serious internal 

changes, which claim the first attention. 
/ 

EYE-GLASSES. 

The use of glasses becomes a necessity or 
convenience, at some time in their lives, to a 



I10W TO TAKE CARE OF THEM. 45 

large proportion of the people of civilized 
communities. If short-sighted, they require 
glasses in youth, as well as in age, for distant 
vision. If possessing normal eyes, they need 
assistance, with advancing years, for seeing 
near objects. The comfort and safety of the 
eyes often depend on a proper selection of 
these auxiliaries. 

The glasses in most common use have their 
two surfaces ground of the same curve, con- 
vex or concave upon each side. Periscopic 
glasses, in whiclTthe two surfaces are of dif- 
ferent curvature, are sometimes worn, as giv- 
ing rather more range of vision without turn- 
ing the head ; but their optical qualities are 
in some other respects less perfect than those 
of the usual form. 

To avoid the trouble of changing from one 
pair of spectacles to another, two different 
foci are sometimes ' combined in the same 
glass, — the lower portion being ground to 
the focus adapted for reading, and the upper 
part to that suited for distant vision. The 



46 OUR EYES: 

same result is also obtained by setting two 
halves of lenses of the two different foci in 
the same frame. 

Cylindrical and prismatic glasses are in- 
tended only for certain special conditions of 
refraction, more common than was formerly 
supposed, and which, when existing, are but 
slightly relieved by the ordinary forms of 
convex and concave glasses. 

Near-sighted persons should select the low- 
est number of glasses which make vision clear 
at a distance without rendering objects small- 
er and unnaturally brilliant. If any difficulty 
is met with in finding such glasses, the eye 
should be examined by some competent au- 
thority to determine if any unusual combi- 
nation of lenses is required, or ascertain the 
presence of disease if the difficulty in suiting 
the eyes arises from this source. 

When convex glasses are required by hy- 
peropic persons for distant vision, they should 
be of such power as to render every thing dis- 
tinct. Those used for reading should make 



BOW TO TAKE CARE OF TIIEM. 47 

print clear at the usual distance, without 
magnifying much. Persons who need glasses 
of different foci for near and distant sight 
should not wear their reading-glasses when 
looking at a distance; for, if they do so, they 
will find them less serviceable in reading or 
sewing, and soon require a higher power. 

The frames of glasses may be round, oval, 
or of any form, and of various material, ac- 
cording to fashion or preference. As a rule, 
light materials and large glasses are best. If 
the nose is so shaped that eye-glasses can be 
kept in place without having too strong a 
spring, they may be worn, if preferred, rather 
than spectacles ; but, if the spring is too 
strong, it often causes pain by its pressure 
on the nerves around the eyes. Cataract 
glasses should generally be mounted as spec- 
tacles ; for they are worn almost continuously, 
and their weight makes it difficult to keep 
them upon the nose if framed as eye-glasses. 

Whatever style of mounting is preferred, 
the frames should be adapted to the form of 



48 OUR EYES: 

the bridge of the nose, and to the distance 
between the eyes ; so that, as a rule, the cen- 
tres of the glasses shall be in front of the 
pupils. Men generally require frames with 
longer bridges than women, because of the 
greater space between their eyes. Silver 
frames are perhaps the most economical for 
the poor, since, if bent or broken, they can be 
repaired. 

Pebbles, as they are called, are often 
praised as having qualities excelling those of 
ordinary glasses ; but this is not the case to 
any considerable extent, even when they are 
made with care and at a much higher cost 
than other glasses. 

Tinted glasses, or those having wire-gauze 
around their border, are often worn as pro- 
tectors against light and dust. When used 
to defend sensitive eyes from light, a mild 
blue is generally more grateful than a neutral 
tint ; but a neutral or French gray may be 
worn if more acceptable to the eye. Green 
glasses are to be avoided in most cases, as 



IJOW TO TAKE CARE OF THEM. 49 

they do not absorb or neutralize the irritating 
rays in the spectrum of light as it passes 
through them. Inflamed eyes often find most 
relief from glasses surrounded by wire-gauze, 
which exclude wind and dust as well as light ; 
but these should not be worn so closely as to 
keep the eyes heated. 

Very thick plate-glasses, set in spectacle- 
frames, are sometimes used as a safeguard by 
stone-cutters,* machinists, &c, whose eyes, 
when unprotected, are often fatally injured 
by the penetration of particles of metal driven 
with great force into the interior of the eye- 
ball. 

THE OPHTHALMOSCOPE. 

In looking into an eye, our unaided vision 
usually penetrates but a little way beyond the 
pupil ; but by means of the ophthalmoscope, 
invented a few years since by Professor Helm- 
holtz of Heidelberg, we are able to explore 
the depths of this organ, and detect the 
smallest variations from a healthy condi- 
tion. 

4 



50 OUR EYES: 

The room being darkened, the rays from a 
light placed near the head of the person to 
be observed are reflected into his eye as if 
they came from the eye of the observer ; and 
the latter, by looking through the central 
aperture in the instrument, can examine the 
illuminated interior of the eyeball, perceiving 
every detail of healthy structure or morbid 
change as accurately and clearly as we can 
see any part of the exterior of the body. All 
this is done without injury or discomfort to 
the eye looked at ; and the diseases of its in- 
ternal parts, heretofore hidden mysteries, can 
be studied and understood perhaps more per- 
fectly than those of any other organ of the 
body. 

The benefits derived from the ophthalmo- 
scope are not limited to the better knowledge 
and earlier discovery of morbid affections of 
the eye itself. This means of observation 
also enables the physician to detect diseases 
of distant organs by the manifestations of 
their presence exhibited in secondary changes 



HOW TO TAKE CARE OF TIIEM. 51 

in the deep-seated tissues of the eye, and to 
avert impending mischief to the brain by 
timely discovery of its indications in the 
optic nerve and retina, in season to counter- 
act the subtle influences threatening life or 
reason. 

DEFECTS OF SIGHT FROM MALEFORMATION OR 
FROM CERTAIN STRUCTURAL CHANGES. 

In a considerable number of cases where 
the eyes of children appear healthy upon an 
ordinary inspection, there is more or less 
want of acuteness in the sight, which is little, 
if at all, relieved by any glasses. Examina- 
tion with the ophthalmoscope shows, in some 
cases, an imperfect development of the retina 
and choroid ; in others, there is commencing 
cataract ; in others, the cornea is slightly 
hazy from previous ulceration, or it is conical 
in its form. 

A frequent symptom in these cases is a dis- 
position to bring objects quite near the eyes ; 
but even then they are but dimly seen, and 



52 OUR EYES: 

not as they would be were the child merely 
near-sighted, — with great clearness. 

Such children should not be required or 
allowed to apply their eyes closely to small 
objects ; and they should be carefully exam- 
ined by a skilful professional man to deter- 
mine the precise condition of the eye and its 
proper management. 

Complete or partial blindness may occur 
during pregnancy, or while nursing ; but this 
should not cause too much alarm, as, if unac- 
companied by permanent morbid changes, it 
may be expected to disappear, slowly, after 
termination of the causes which gave rise to 
it. But careful inquiry should be made as 
to the presence of any complicating circum- 
stances ; for, if such exist, the spontaneous 
recovery of sight cannot be so confidently 
hoped for. 

BAD PRINT. 

No protest can be too earnest against the 
manner in which many books, especially 



HOW TO TAKE CARE OF THEM. 53 

school-books, are printed. Surely, if an au- 
thor's work has any value, it deserves 'better 
than to be sent forth in so poor a garb. 
What is worth printing at all, at least as re- 
gards books intended to be constantly used 
or extensively read, is worth being well 
printed, with clear type, upon a fair page. 
Every thing should be done, so far as the arts 
may serve the interests of learning and sci- 
ence, to make study a pleasure, instead of 
rendering it an irksome and injurious task. 

If and while eyes are strong they may 
offer only feeble remonstrance against the 
harm they suffer in being forced to decipher 
that which bad type, ink, and paper have 
combined to make illegible, yet the day of 
reckoning comes at last, and many eyes must 
cease their labors, and many minds, full of 
useful projects, must abandon their plans, 
because the eyes, those long-enduring instru- 
ments of research, have given way to the 
continued strain to which they have been 
needlessly subjected. 



54 OUR EYES: 



WOUNDS AND INJURIES OF THE EYE. 

The subject of accidental injuries of the 
eye is one of great importance, as the recov- 
ery or loss of sight may often depend on what 
is done immediately after the accident, before 
the eye is seen by a physician. 

Travellers, especially by railroad, are liable 
to the lodgement of small particles of dust or 
cinders inside the lid, or upon the front of 
the eyeball, causing great suffering. These 
should be removed as soon as possible, before 
the eye becomes excessively sensitive, and 
before they give rise to inflammation. Some- 
times these foreign bodies are to be seen, on 
close inspection, lodged in the front of the 
cornea, where they are not felt when the eye 
is open, though every movement of the lid 
over them causes much pain. If not firmly 
embedded, they may be removed by means of 
a bit of wood, say a toothpick, sharpened to 
a flat point, or even by a camel's-hair brush ; 
but, when forcibly implanted, they are some- 






HOW TO TAKE CARE OF THEM. 55 

times so firmly held in place, that their ex- 
traction requires a skilful hand. When fixed 
in the centre of the cornea, with the dark 
pupil as background, they are frequently 
overlooked at a first inspection. If the for- 
eign body is not found in this situation, it 
will be discovered, in nine cases out of ten, 
inside the upper eyelid, and generally at 
about the centre of the lid, near its border. 
Thus placed, it scratches the cornea at each 
motion of the lid or eyeball, and causes great 
irritation. Such particles, once slightly em- 
bedded in the membrane lining the lid, may 
remain there a long time before being ex- 
pelled by natural efforts. 

If the eyelids are closed for a few minutes 
soon after the entrance of the foreign body, 
so as to allow the tears to accumulate, and 
the skin at the centre of the upper lid is then 
taken hold of with the thumb and finger, and 
drawn forward so as to lift the lid from the 
eyeball, the intruding particle is often washed 
away with the outflow of tears. 



56 OUR EYES: 

If relief is not obtained after two or three 
trials of this plan, and no physician is at 
hand, it will be best to ask a travelling-com- 
panion to turn the lid, and remove the offend- 
ing substance ; but, if this should be a grain 
of light-colored dust or sand, good eyes or 
eye-glasses will be needed to detect it. 

The upper eyelid may be easily turned by 
taking hold of the eyelashes and edge of the 
lid with the thumb and Auger of the left, 
hand, and drawing the lid outwards and up- 
wards ; while at the same time a small pen- 
cil, a knitting-needle, or some similar thing, 
held in the right hand, is placed against the 
centre of the lid, pressing it backwards and 
downwards towards the eyeball. The person 
should look down, as this greatly facilitates 
the e version of the lid, which may be easily 
accomplished if these directions are followed. 
The cinder or dust may then be wiped off 
with a handkerchief or the finger. 

Smoothly-worn bits of shell from the beach 
are sometimes inserted as " eye-stones ; " the 



HOW TO TAKE CARE OF THEM. 57 

popular idea being, that they pursue the for- 
eign body, and bring it out, vi et armis. But 
these, generally, only add to the sufferer's 
discomfort; and in the few instances where 
their introduction is followed, after more or 
less delay, by the escape of the original in- 
truding substance, they merely serve by their 
bulk to separate the eyelid from close contact 
with the globe, and thus allow the sand or 
cinder to be washed from its position by the 
abundant tears. Much harm is often done 
by their presence, the remedy proving even 
worse than the disease. 

It is so common for machinists and stone- 
cutters to have atoms of metal driven into the 
cornea, that, in most shops, some one of the 
workmen acquires repute for a certain skill 
in removing them. But, when the metal is 
deeply lodged, their efforts often fail ; and the 
cornea is sometimes injured by their attempts, 
or so much abraded, that the eye becomes 
exquisitely sensitive ; and, when the sufferer 
applies for professional aid, it is almost im- 



58 OUR EYES: 

possible for him to keep the eye still enough 
to allow of the extraction of the metallic 
fragment. Sometimes etherization is neces- 
sary in such cases before the removal of the 
foreign body can be effected. 

But workmen are also liable to far graver 
injuries from bits of metal which penetrate 
the eyeball instead of lodging upon its sur- 
face. In using a hammer and cold-chisel, 
small bits of steel are often broken from the 
edge of the tool, and driven with great force 
into the eye. Having once passed through 
the tough external coats of the eyeball, there 
is little to prevent their going on to the very 
bottom of the eye. These accidents are very 
deceptive. The workman, perhaps, thinks his 
eye has only been hit externally by a bit of 
metal which he was chipping off ; and as he 
feels at first very little pain, and his vision, it 
may be, is not much affected, he is unwilling 
to believe that any thing has entered the 
globe. But, if examined, conclusive traces 
are often found of the course of the missile 



HOW TO TAKE CARE OF THEM. 59 

towards the back of thg^ eye ; or it may 
sometimes be seen lodged in the iris or the 
crystalline lens ; or the ophthalmoscope may 
even detect its presence in the deeper parts 
of the globe. Usually the man is soon con- 
vinced, by the continued irritability of the 
eye and the increasing failure of his sight, 
that his is more than an ordinary trivial in- 
jury- 

Many eyes are yearly lost from bits of per- 
cussion-caps, which boys amuse themselves 
in exploding by carelessly striking them with 
a stone or hammer. Such dangerous play- 
things should be absolutely forbidden. 

In any of these cases, no time should be 
lost before consulting a skilful oculist, if pos- 
sible ; if not, the ablest medical practitioner 
within reach ; as the chance not only of re- 
taining any vision in the wounded eye, but 
of preserving it in the other, may depend on 
the advice given and the treatment adopted 
immediately after the injury. The possibility 
or expediency of the removal of the foreign 



60 OUR EYES: 

body should be determined by a man of ex- 
perience ; as, if such a substance is allowed 
to remain in certain parts of the eyeball, it 
excites, in very many cases, a peculiar form 
of sympathetic inflammation in the other eye, 
and destroys the sight. 

Grains of powder are frequently driven 
into the eye by premature explosions, &c. 
If near the centre of the cornea, and of some 
size, they should be carefully picked out, as 
far as may be, soon after the accident. But 
small particles may remain, even in the cor- 
nea, without doing harm ; and, if they have 
been some time in the eye, they become in- 
corporated in the surrounding tissues, and 
should not be disturbed unless they cause 
conspicuous deformity. 

Burns, or injuries from acids or other 
chemical substances, or freezing of the cor- 
nea during exposure to intense cold, are usu- 
ally followed by dangerous ulceration, or 
even by complete loss of vitality in the cor- 
nea. Such cases should never be neglected. 



110 W TO TAKE CARE OF TIIEM. Gl 

Clean cuts of the eyeball, with sharp in- 
struments or pieces of glass, even when quite 
large, often result in a good recovery. La- 
cerated wounds, made by blunt instruments, 
sticks, horns, and the like, terminate less fa- 
vorably. In all these cases, the friends of the 
injured person should avoid curious meddling 
with the eye " to see how much it is hurt; " 
and it is well to keep both the eyes closed 
and quiet, as if asleep, that the wound may 
be as little disturbed as possible until it can 
be seen by a physician. No other applica- 
tions should be made than a thin, folded rag, 
wet with cold water ; close, heavy bandages, 
which might press heavily upon the eye, and 
every thing like poultices, being especially 
avoided. No eye-water of any description 
should be used, except under the direction 
of the medical adviser ; for the redness and 
swelling of the eye ball and lids depend on 
the existence of the wound, and will subside 
as this is healed, but are not to be got rid of 
by mischievous activity in the use of such 



62 OUR EYES: 

remedies as might be serviceable in a differ- 
ent form of inflammation. 

Penetrating wounds of the eye from scissors, 
pin-darts, needles, &c, may be trivial, if the 
important internal parts are not involved ; but 
they are often more serious than appears at 
first sight. And the fact that a child makes lit- 
tle complaint after such an injury should not 
put a parent off his guard : for in these cases, 
as in most lacerated wounds and those pro- 
duced by blows from blunt objects, we have to 
fear, not merely loss of vision, but shrinking 
or deformity of the eyeball ; and, what is far 
more serious, there is, in many cases, a risk of 
loss of the other eye from sympathetic inflam- 
mation. This last consequence is especially 
likely to happen if the injured eye continues 
irritable and sensitive, or if it becomes so 
after having been for a time free from active 
symptoms. 

The very frequent occurrence of total loss 
of sight from sympathetic disease coming on 
insidiously in the internal parts, and with 



HOW TO TAKE CARE OF THEM. 63 

very little warning, ought to be kept in view 
in every case of injury of the eyeball, until 
such time as the danger is pronounced by some 
competent authority to be past ; and, if threat- 
ening symptoms present themselves, there 
should be no hesitation in sacrificing the in- 
jured globe, if necessary to the safety of the 
other eye. 

SYMPATHETIC INFLAMMATION OF THE EYE. 

When one eyeball has been seriously in- ■ 
jurecl, or a foreign body remains within it, 
especially in the ciliary region, a little behind 
the line of union of the transparent cornea with 
the sclera, or in some instances of displace- 
ment or disorganization of internal parts, the 
other eye, previously healthy, becomes affect- 
ed with a slow internal inflammation of a 
most destructive nature. 

The early symptoms are often so slight as 
not to attract notice, unless they have been 
watched for ; and they are at length observed 
only too late for effective treatment, if they are 



64 OUR EYES: 

looked for only in the uninjured eye. The first 
premonitory signs are to be seen in the eye 
which has been diseased or hurt ; and it should 
be vigilantly watched as long as any sensitive- 
ness lingers to justify suspicion. 

Should warnings in the injured eye be dis- 
regarded, the other eye may begin to show a 
faint blush of redness just beyond the margin 
of the cornea; the movements of the pupil 
become sluggish ; and it is perhaps found that 
vision is less good than usual in a feeble light. 
These changes increase, though varying, and 
seeming to improve at times ; until at last the 
eye becomes very red, watery, and perhaps 
painful ; the pupil is closed by a deposit of 
opaque material ; and the globe finally shrinks, 
and is sightless. 

Occasionally an eye escapes without loss of 
vision after these processes have begun, pro- 
vided the injured eye, the source of the sym- 
pathetic irritation, is promptly removed ; but 
it is best, where the state of the other eye 
indicates a tendency to mischief, not to wait 



HOW TO TAKE CARE OF THEM. 65 

for the appearance of even slight symptoms 
of disease in the sound eye, as, unfortunately, 
they cannot always be arrested, when once 
established, by even the promptest action on 
the part of the surgeon. 

When an eyeball is removed under these 
circumstances, there is often an immediate 
sense of relief from dull pain which had pre- 
viously existed in the eyes and forehead. The 
globe being enucleated without the removal 
of the muscles and other contents of the orbit, 
a sufficient support is left for an artificial eye. 
Though such an operation is formidable in 
anticipation, it is painless in execution after 
etherization ; and the wound is readily healed, 
often within two or three days. 

More or less serious changes may occur 
within the eye as the result of concussion, 
without external wound ; as, for instance, 
from a hit by a cork from a bottle, the end 
of a whip-lash, a ball, or any other sudden 
shock. The anterior chamber, the space be- 
tween the cornea and the iris, is often at once 

5 



66 OUR EYES: 

filled with blood, and vision temporarily lost ; 
but the blood is re-absorbed and sight restored 
in a few days, if no other harm has been re- 
ceived. The iris may be partially torn or sep- 
arated at its border, forming a second pupil, 
but not seriously damaging the visual func- 
tions. Sometimes the crystalline lens is dis- 
located, or the capsule enclosing it is ruptured. 
This may lead to inflammation by pressure 
upon neighboring sensitive parts ; or, where 
no change is immediately apparent, may result 
in the formation of cataract, the lens gradu- 
ally becoming cloudy within a few months ; 
or the retina may be separated from its con- 
nections, and its perceptive faculty destroyed. 
As, in any such injury from concussion, there 
is a possibility of sympathetic ophthalmia at 
a subsequent period, all such cases should 
receive careful attention. 

ARTIFICIAL EYES. 

When vision is lost in one eye, and the 
globe is more or less disfigured or shrunken, 



HOW TO TAKE CARE OF THEM. G7 

a person is often desirous to conceal the de- 
formity, in order not to attract notice, and to 
restore the natural expression of the features. 

An artificial eye may be worn when the 
eyeball is but slightly lessened in size, or 
when the globe has been removed ; but the 
most favorable condition for its use is where 
the anterior parts of the eye have been de- 
stroyed or removed, leaving a somewhat di- 
minished globe, to which the muscles remain 
attached. It is important that no extensive 
adhesions should exist between the eyeball 
and the lids. 

Artificial eyes are in the form of a thin 
shell, made of a sort of glass termed enamel, 
and as light as possible, that they may be 
moved readily by the muscles of the globe in 
harmony with the movements of the other eye. 
They should not be too large, as, in this case, 
their movements will be limited. The form 
should be adapted to that of the socket in 
which they are to be worn, their edge not 
pressing too much against any part of it. 



68 OUR EYES: 

They should appear, when worn, a little 
smaller, rather than larger, than the other 
eye, as a staring look is thus avoided. In 
color and in size of the iris and pupil, they 
should correspond as nearly as possible with 
the other eye ; but a difference of color is of 
less importance than to have the eye of a 
form and size which will be comfortable and 
movable. 

Very slight differences greatly alter the 
effect of the eye when inserted. It is, there- 
fore, very difficult to obtain a suitably-fitting 
eye, except by personal selection from a large 
number of specimens ; and, if once well fitted, 
a person would do well to order other eyes of 
the same pattern, otherwise it may not be 
easy to replace an eye with another as well 
adapted, when the first becomes rough or is 
broken. 

Like other modern substitutes for natural 
deficiencies, — hair, teeth, wooden legs, &c, — 
artificial eyes should be laid aside at night. 
In fact, it is well to take them out occasion- 



HOW TO TAKE CARE OF THEM. 69 

ally in J:he clay-time, and bathe the orbital 
cavity, in order to avoid the slight irritation 
caused by their constant presence, and to 
preserve the eyes from becoming roughened 
by constant soaking in the tears and other 
discharges. But, even with these precautions, 
the surface of the enamel loses its polish after 
a while, usually in from one to three years ; 
and the eye must then be exchanged for an- 
other. If worn after becoming rough, the 
secretions from the lining of the cavity are 
greatly increased ; and it becomes inflamed, 
and covered with fungous granulations to such 
an extent, that the artificial eye can no longer 
be introduced. But these granulations, how- 
ever large, must be left to shrink away under 
the soothing effect of frequent lotions with 
water or other mild means. If they are cut 
off, the cavity is almost always rendered 
smaller, and subsequently will not admit the 
false eye. Of course, in these circumstances, 
the eye must be laid aside until the recovery 
of the healthy condition, 



70 OUR EYES: 

Where a good fit, well matched T^ith the 
other eye, is obtained, artificial eyes are not 
to be detected by an ordinary observer ; and 
they restore good looks and a natural ex- 
pression to the face, so completely, that, after 
a time, even a person's friends forget the 
counterfeit. They require care, however, 
both in their selection and use ; and those to 
whom looks are a matter of slight considera- 
tion sometimes find them more trouble and 
expense than they think them worth. 

CREDULITY AND PRESUMPTION IN REGARD TO 
THE EYE. 

The willingness of the public to patronize 
pretended oculists, and to recommend certain 
popular remedies as being infallible for the 
cure of eye-disease, is a source of pain to 
every one who witnesses in our hospitals and 
blind-asylums the lamentable consequences. 
Intelligent people would be slow to confide 
their important business, their farms and 
merchandise, to the hands of travelling law- 



nOW TO TAKE CARE OF TIIEM. 71 

yers of uncertain reputation, whom they saw 
for the first time, and never expected to see 
again: yet they intrust their eyes, worth 
more than house or lands, to the care of 
roaming pretenders, whose own assurances 
are the only warrant of their skill ; and who, 
when their ignorance and failures become too 
glaringly evident in one place, flee into 
another. Or, again, a mother thinks it no 
harm to follow the recommendation of nurse 
or neighbor, and apply a poultice to the in- 
flamed eyelids of her babe ; little dreaming, 
that, in so doing, she is dooming it to blind- 
ness, and never asking herself how much the 
presumptuous adviser could know about the 
matter. An individual who has suffered 
from some affection of the eye, and found re- 
lief in a certain remedy, too often seems to 
feel himself authorized to advise all the rest 
of mankind attacked with eye-disease to use 
the wonderful specific to which he ascribes his 
cure. One person spoils the eye of a friend's 
child by recommending a wash containing 



72 OUR EYES: 

sugar of lead ; another, equally ignorant where 
he assumes to be wise, destroys sight by ad- 
vising, in a case of internal disease, a wholly 
inappropriate eye-water, because it had suited 
his own case of external inflammation. 

The dictates of good sense would really 
seem to be forgotten where the eye is in 
question : for surely, if there be any faculty 
of the bodjr of pre-eminent importance and 
value, it is the faculty of seeing ; and, if there 
be any organ whose delicate and intricate 
structure demands the most patient and in- 
telligent study and finished skill for its prop- 
er comprehension and successful manage- 
ment, it is the organ of vision. Yet this 
seems to be a lesson which the community is 
most unwilling to learn ; and multitudes of 
eyes, too valuable to be thus thrown away, 
are sacrificed to ignorance and neglect. 

DISEASES OF THE EYELIDS. 

The edges of the lids are often thickened* 
and nrasted, and the eyelashes fall out, in 



HOW TO TAKE CARE OF THEM. 73 

consequence of neglected disease of the roots 
of the lashes, and the lubricating glands which 
open near them. 

If left to themselves, the lids grow more 
and more unsightly, the bulbs which form 
the eyelashes are at last destroyed, and no 
new growth is produced, the margin of the 
lid being left bare and rounded. Yet the 
healthy condition may be easily restored and 
preserved by a little care and the seasonable 
use of proper applications. The crusts should 
not be allowed to remain upon the edge of the 
lids, and give rise to ulceration, but should be 
softened with warm water, and removed with- 
out violence. 

After the thickening has continued a long 
time, the parts are not at once restored to a 
normal state ; and the mild remedies pre- 
scribed by the physician must be patiently 
continued, and should even be used occasion- 
ally after the disease has been subdued, to 
give a healthy tone to the parts, and prevent 
an}- re-appearance of the symptoms. 



74 OUR EYES: 

Rounded tumors are sometimes slowly 
formed in the lid, at a distance from its mar- 
gin, which are seldom dispersed by local ap- 
plications, but require a slight surgical opera- 
tion for their removal. They should not be 
allowed to become very large. 

Erysipelatous inflammation of the lids 
causes much swelling and redness ; and an 
abscess sometimes results. Should this oc- 
cur, it should be opened as soon as possible, 
otherwise the skin of the lid is extensively 
undermined by the matter which spreads be- 
neath it. But this should be done with 
great care, lest the eyeball itself should be 
injured. 

The swelling of the lids which accompa- 
nies inflammation of the tear-sac resembles 
that caused by erysipelas, and is often mis- 
taken for the latter when it is so great as to 
close the eyes ; but it may be distinguished 
from erysipelatous disease by the greater 
hardness and tenderness near the nose, over 
the region of the sac. 



HOW TO TAKE CARE OF THEM. 75 

OBSTRUCTIONS OF THE TEAR-PASSAGES. 

Great suffering results from want of atten- 
tion to the early symptoms of obstruction to 
the proper flow of the discharges from the 
eye. The lining of the tear-passages is often, 
at first, merely thickened, and its healthy 
state may be easily restored ; but, if neglected, 
the lachrymal sac, the reservoir placed in the 
side of the nose to receive the secretions from 
the eye, acquires a condition of chronic in- 
flammation ; and the passage leading down- 
ward from it becomes more or less completely 
closed, perhaps requiring tedious and painful 
treatment for its restoration. When in this 
condition, a slight exposure may cause in- 
flammation of the sac, with great pain and 
swelling of the surrounding parts, often mis- 
taken for erysipelas. Matter rapidly forms ; 
and, if the sac is not promptly relieved, it 
bursts, and the pus spreads beneath the skin, 
and at last finds its way to the surface, form- 
ing a fistula lachrymalis, which is annoying, 
and difficult to heal. 



76 OUR EYES: 

. Formerly, leaden or other styles, or gold or 
silver tubes, were inserted into the sac and 
the duct leading thence to the nose, and were 
worn for a long time ; but this unsightly 
and often ineffectual means has given place 
to milder and more successful methods of 
dilatation. Prevention, however, easily ac- 
complished, at first, by the use of the mildest 
remedies, is better than the cure of these 
obstructions. 

STRABISMUS. 

Strabismus, or squinting as it is often 
termed, is a deviation of the eyes from their 
proper direction in looking at objects. Its 
most common form, where one or both eyes 
turn towards the nose, is, as I have already 
shown, associated with hyperopia in a large 
proportion of cases. As it usually shows it- 
self about the time when a child begins to 
look carefully at objects, and is especially 
likely to occur if the child • is enfeebled by 
illness, its origin is often attributed to an at- 



HOW TO TAKE CARE OF THEM. 77 

tack of whooping-cough, measles, or other 
disease. 

It is a great mistake to allow this abnormal 
turning of the eyes to continue unrelieved 
for years, as is too often the case. Especial- 
ly is this true where the squint seems to af- 
fect one eye only ; for the eye which habitu- 
ally deviates does not receive images of 
objects which harmonize with those in the 
other eye, and, after a time, disregards the 
impressions made upon it, and gradually loses 
its perceptive power. It is common for par- 
ents to wait, first " to see if the eyes will not 
come right," and afterwards " to let the child 
decide, when old enough,'* whether he wishes 
to have the deformity relieved. This would 
be a very proper course if it were merely a 
question of appearances, and the sight did 
not also become involved by delay. 

If the other eye be covered, it will often 
be found that the child sees less well with 
the squinting eye : and this loss of acuteness 
of vision increases and becomes confirmed 



78 • OUR EYES: 

with time ; so that, though an operation done 
at a later period may remove the deformity, 
it cannot restore the diminished visual power. 

At first, the disposition to turn in is per- 
haps noticed only when the child is fatigued, 
excited, or ill; but if this becomes, after a 
few months, more and more constant, it is 
best not to defer, treatment. This does not, 
however, necessarily involve an operation ; 
for the disposition to squint may often be con- 
trolled by suitable glasses, which take away 
the necessity for the excessive calling into 
action of the internal recti muscles. But, if 
an operation is required, there is no excuse 
for postponing it, in these days of etheriza- 
tion, from a reluctance to subject the child to 
pain. 

When the squint is considerable, it is often 
necessary to divide the muscle which is af- 
fected, in both eyes, in order to insure a per- 
fect result ; the deformity and the defective 
optical conditions being only partially re- 
lieved by an operation on one eye only. Af- 



110 W TO TAKE CARE OF THEM. 79 

ter operation, it is often essential that convex 
glasses should be worn, at least for study and 
fine work. 

The opposite deviation, where the eye 
turns outward, is most frequently a conse- 
quence of near-sightedness, resulting, in many 
instances, from alteration of the shape of the 
posterior part of the eyeball, rendering its 
motions less free in the socket. This dis- 
eased condition makes it more difficult to 
remove the deformity by operative means 
than in convergent strabismus ; and the con- 
dition of* the interior of the eye should be 
carefully examined to ascertain if progres- 
sive and dangerous myopic, changes are in 
progress. 

Temporary or permanent strabismus may 
also occur where the nerves which supply the 
motor muscles of the eyeball are paralyzed 
from the action of external causes, or from 
disease of the brain. The cure in these 
cases must depend on the removal, if pos- 
sible, of the original paralyzing influence. 



80 OUR EYES: 

DISEASES OF THE CONJUNCTIVA. 

Some of the affections of the conjunctiva, 
the mucous membrane covering the front of 
the eyeball and lining the lids, are among the 
most fatal to vision ; and their frequency, and 
oftentimes their severity, their tendency to 
linger, and the danger of their being com- 
municated from one individual to another, 
give them an important place among the dis- 
eases of the eye. 

INFLAMMATION IN NEW-BORN CHILDREN. 

Within a few days after birth, the lids 
of one or both eyes sometimes become red 
and swollen, and a creamy matter begins to 
form. Except where the affection is slight, 
the symptoms rapidly increase ; the lids swell 
so much as to project beyond the eyebrows, 
and completely close the eyes ; the discharge 
of matter becomes so copious, that it pours 
out in great quantity if the lids are sepa- 
rated ; and the eyeball itself becomes in- 
volved. 



HOW TO TAKE CARE OF THEM, 81 

If the disease is not checked, the transpar- 
ent front of the eye, the cornea, is liable to 
more or less complete destruction from ulcer- 
ation. This may take place suddenly, from 
the extreme severity of the inflammation ; or 
it may occur only after the symptoms have 
already diminished, — the cornea holding out 
for a time, but at last yielding to the effects 
of the inflammation of the surrounding parts, 
and the constant flowing over it of the 
abundant and irritating discharges. 

The liability to ulceration of the cornea 
renders this disease a source of great anxiety 
to even those of most experience ; yet it is 
common to see the management of these 
cases undertaken by nurses or friends whose 
little knowledge is worse than ignorance, and 
who waste precious time in trying worthless 
means, until it is discovered, too late, that 
fatal injury has been done to vision. 

Cleanliness is of the first importance in 
these cases, not only for the safe recovery of 
the eyes affected, but to lessen the danger 



82 OUR EYES: 

of contagion. Many an eye has been lost in 
consequence of being touched with a finger 
or a towel or handkerchief which had been 
in contact with matter from the eye of the 
babe. The discharge must not be allowed to 
remain in the eye, but should be thoroughly 
washed out every hour or half-hour, if neces- 
sary, by means of a small syringe, introduced 
under the swollen upper lid, so as to com- 
pletely cleanse the eye from the accumulated 
secretions. Applications to the outside of 
the lids, such as poultices, &c, should be 
absolutely abstained from, as they are highly 
dangerous. It is important that the medical 
adviser should see the disease in its earliest 
stages ; as its fearful progress may often then 
be cut short, or its severity mitigated. 

INFLAMMATION FROM EXPOSURE TO COLD OR 
DUST. 

The most common affection of the external 
membranes of the eye results from the action 
of cold or dust, or some similar source of irri- 



HOW TO TAKE CARE OF THEM. 83 

tation. It may also extend through a family 
or neighborhood, where the same towels or 
wash-basins which have been used by an in- 
dividual having sore eyes are made to serve 
for other persons. 

The pain complained of is a smarting or 
itching, as if sand or sticks were in the eye ; 
and matter is discharged in greater or less 
amount, frequently causing adhesion of the 
lids together during the night. 

The disease is often easily relieved at the 
outset by suitable remedies ; but if these are 
neglected, or if inert or too harsh measures 
are resorted to, the symptoms are aggravated 
or indefinitely prolonged, the disease having 
little tendency to spontaneous cure. Exam- 
ples are constantly seen of the melancholy 
results of inattention and mismanagement. 
Working-men are unwilling to lose time in at- 
tending to their eyes during the early period ; 
and when, at last, they seek advice because 
they are unable to work any longer, the 
slight changes of structure at the beginning 



84 OUR EYES: 

have become so great, that months instead of 
days are required for the restoration of the 
healthy condition. When not absolutely neg- 
lected, the eyes are often tampered with, 
and with ruinous results. The catalogue of 
substances in popular repute as sure means of 
relief would be almost endless. Of these, a 
few would be useful if employed in cases to 
which they were suited ; but most of them are 
worthless, and many injurious. 

INFLAMMATION FROM CONTAGION. 

Rapidly fatal ulceration of the cornea may 
ensue upon inflammation of the conjunctiva 
following the introduction of a minute parti- 
cle of contagious matter; eyes being some- 
times thus totally lost in from twenty-four to 
forty-eight hours. Immediate and skilful 
treatment is imperative if the eye is to be 
saved. Great care should be taken to pre- 
serve the other eye, as well as those of any 
persons who may be exposed, from inocula- 
tion with the virulent discharge by a careless 



HOW TO TAKE CARE OF THEM. 85 

touch with the fingers or with any thing 
which may have been infected by it. 

GRANULATIONS OF THE EYELIDS. 

After long-continued inflammation, and 
frequently without this, the inner surface of 
the upper lid may become rough from the 
formation of what are termed granulations. 
Sometimes these are almost cartilaginous in 
their hardness ; and their constant friction 
upon the cornea a thousand times a day, 
every time the eye rolls or the lids wink, 
leads to dangerous alterations of its condition. 
The cornea loses its smoothness and trans- 
parency; blood-vessels are developed where 
none ought to be visible ; and at last ulcera- 
tion and perforation take place, causing more 
or less implication of internal parts, and in- 
jury .to vision. 

When the front of the eye has become so 
entirely clouded that the person cannot find 
his way or do more than perceive light, great 
patience and confidence are required on the 



86 OUR EYES: 

part both of the sufferer and his physician. 
Speedy removal of the morbid changes is 
wholly impossible : until the roughness of the 
eyelids has been greatly lessened, the cloudi- 
ness of the cornea can be but little diminished ; 
for, the cause continuing to act, the effect re- 
mains. It is hard for a person and his friends 
to believe that he is improving, and is even 
nearly well, when he cannot perceive that 
he sees much, if at all, better. Yet this may 
be the case ; it being only when the granula- 
tions have been almost removed that the cor- 
nea recovers from the effects of their friction, 
and its clearness is gradually restored. There- 
fore the sufferer should take courage if his 
eyelids are made more comfortable, and the 
discharge from them grows less; and treat- 
ment should be hopefully continued till the 
amelioration of some of the conditions pre- 
pares the way for an evident improvement of 
his sight. No advantage is obtained from 
frequent changes of remedies in the hope of 
a more rapid gain. 



HOW TO TAKE CARE OF THEM. 87 

It is important that the granulations should 
be entirely removed. Those who have been 
blind for months or years are too often so re- 
joiced at the recover)^ of sight and of a com- 
fortable state of the eyes, that they disregard 
the lingering of some remains of disease be- 
neath their- lids which may be roused by 
slight causes to renewed activity. They are 
anxious to return to their occupations, and 
hope their eyes will go on in their course of 
improvement. It is unsafe, however, to in- 
dulge this hope prematurely ; and treatment 
should not be abandoned till all parts of the 
lining of the lid have been brought to so 
healthy a state, that the inconveniences and 
dangers of a relapse are no longer to be 
feared. 

ULCERATIONS OF THE CORNEA IN CHILDREN. 

Ulcers of the cornea, most frequently near 
its centre, are very common in young chil- 
dren. They are attended with intolerance 
of light, sometimes so extreme, that the child 



88 OUR EYES: 

gives up all his usual pleasures, and even his 
food, to keep the lids day after day spasmodi- 
cally closed, and the head buried in cushions 
or pillows. In other cases, the eyes can be 
opened in the afternoon or evening ; though 
they shrink from the morning light. Chil- 
dren often become restless and peevish ; the 
whole disposition being changed during the 
continuance of the disease. These cases dif- 
fer greatly in their duration, and, if neglected, 
may be prolonged for months, till the health 
suffers from want of air and exercise. • 

It is usually possible, by engaging the 
child's attention, to obtain a look at the eye 
in a moderate light, so as to ascertain the ex- 
tent of the ulceration, without resorting to 
forcible opening of the lids. 

• Even -when superficial, these ulcers usually 
leave behind them a temporary cloudiness of 
the cornea ; and, if they penetrate deeply, 
they cause a permanent opacity, which, 
though it may lessen in extent and density, 
does not wholly disappear, but affects vision 



HOW TO TAKE CARE OF THEM. 89 

in a greater or less degree. It is, therefore, 
very desirable that the ulcerative process 
should be arrested as soon as possible, to 
shorten the term of suffering, and avert the 
injury to sight. 

Solutions of sugar of lead, a favorite popu- 
lar remedy, should be avoided with especial 
care in all diseases of the eyes in children ; 
since, where ulceration' exists, the lead solu- 
tion is decomposed, and forms an indelible 
white deposit upon the ulcerated surface. 
Laxative medicines or blisters, so often used 
as domestic prescriptions in the hope of clear- 
ing the system of "humors," are also objec- 
tionable ; the child more often needing tonics 
and good diet than any debilitating treat- 
ment. 

Small pimples, of which there may be one 
or several at or near the edge of the cornea, 
upon the white of the eye, must not be mis- 
taken for the ulcerations above referred to. 
They are of comparatively trivial importance, 
and can be disposed of in a few clays by the 



90 OUR EYES: 

use of mild lotions, which are better th$n more 
severe treatment. 

INFLAMMATIONS OF INTERNAL PARTS OF THE 
EYE. 

A brief reference to a few points will show 
how suicidal is the course often pursued in 
neglecting disease of the important internal 
structures of the eye until their vitality is 
wholly destroyed, and recovery of vision 
hopeless. 

Some of the most serious of these changes 
are attended with little pain, and perhaps 
give warning of their progress only by dimin- 
ished sight. When pain occurs, as in the 
cases of acute inflammation, it differs from 
the smarting or itching sensations accom- 
panying most of the forms of external inflam- 
mation, and has a deep-seated aching charac- 
ter, often extending along the nerves in the 
neighborhood of the eye, and sometimes 
more severe in the forehead and temples 
than in the eye itself. Any such pain, there- 



HOW TO TAKE CARE OF Til EM. 91 

fore, especially if accompanied by dimness of 
sight, should receive immediate attention as 
a warning of impending mischief. 

As might be supposed, most of the reme- 
dies which prove useful in the treatment of 
inflammations of the external membranes of 
the eye are not at all adapted to affections 
of the internal parts, and can only be hurt- 
ful if applied. 

INFLAMMATION OF THE IRIS. 

This curtain, stretched across the interior 
of the eye, and from which it takes its color, 
— blue, hazel, &c, — is frequently the seat 
of inflammation. Generally this is attended 
with pain, extending to the brow, or even to 
the whole of that side of the head, and usu- 
ally more severe at night. The eye is often 
quite red, especially around the cornea ; but, 
in some cases, there is little to attract atten- 
tion to the eye. There is usually a copious 
flow of tears, but little thick mucous dis- 
charge. 



92 OUR EYES: 

The source of danger lies especially in the 
tendency to closure of the pupil by adhesion 
of its edges to neighboring parts. The 
thickened iris lies in contact with the crystal- 
line lens ; and the lymph thrown out from it, 
similar to the material which unites the 
edges of ordinary flesh-wounds, forms de- 
posits which cement the margin of the pupil 
to the lens behind it, and often completely fill 
its area. This misfortune may be avoided by 
timely treatment, the iris and lens being kept 
from contact with each other till the inflam- 
mation subsides. This is of great impor- 
tance to the actual and prospective safety of 
the eye. If adhesions have already formed, 
they may sometimes be detached, while still 
recent, by the use of remedies ; but, if neg- 
lected, they become firmly fastened, and can 
only be separated by surgical means. 

Even slight adhesions increase the danger 
in case of future attacks of the 'disease; but, 
where the pupil has become entirely closed, 
immediate surgical interference is necessary 



nOW TO TAKE CARE OF THEM. 93 

to prevent a slow, destructive process result- 
ing from pressure of the accumulating fluids 
behind the iris, which can no longer find 
their way through the pupil. 

Strong light and much use of the eyes 
should be avoided during the attack. 

Persons of rheumatic constitution are 
liable to repeated visitations of iritis, which 
may occur at longer or shorter intervals. 
They should be careful to give prompt atten- 
tion to the earliest symptoms, — slight pain 
or dimness, or soreness on moving the eye- 
ball, — as a prolonged attack may often be 
averted if the eye is at once placed under 
the influence of suitable remedies. 

GLAUCOMA, 

One of the diseases most absolutely fatal 
to vision if neglected, or if inefficiently 
treated, is glaucoma. , It is most frequent in 
women ; usually occurs after the middle 
period of life ; and often follows physical or 
mental depression resulting from fatigue in 



94 OUR EYES: 

watching with sick friends, or grief in 
mourning their loss* 

The pain in acute attacks is agonizing : 
but it is often felt so much more severely in 
the nerves in the vicinity of the eye than in 
the globe itself, that these symptoms are fre- 
quently mistaken for facial neuralgia ; and, 
notwithstanding the loss of sight, the pri- 
mary seat of the disease is overlooked. The 
eyeball becomes hard; the cornea loses its 
sensibility, so that it may be touched with 
a probe without causing pain; the iris is 
pushed forward and the pupil dilated by the 
overcrowding of parts behind it; and all 
vision, even the perception of light, may be 
lost within a few days. There is often very 
little redness of the eyeball. These symp- 
toms now and then subside for a time, to re- 
turn after a longer or shorter interval with 
renewed force. 

The attack is often preceded by a neces- 
sity for rapidly increasing the strength of the 
glasses worn for reading, and by an appear- 



# HOW TO TAKE CARE OF THEM. 95 

ance of rainbow-colors around the light on 
looking at a lamp in the evening, or of a 
fog or white sheet thrown over objects in the 
daytime. 

On examination with the ophthalmoscope, 
the entrance of the optic nerve, if still visi- 
ble, shows a cup-like depression, — a result 
of the extreme pressure within the globe. 
As the disease goes on, the transparent inter- 
nal parts grow cloudy, so that the optic nerve 
can no longer be seen ; the globe becomes of 
a stony hardness ; the pupil is enlarged to the 
utmost ; the iris is thinned by pressure ; the 
lens is crowded forward until it lies against 
the cornea and takes a sea-green color ; and 
hopeless disorganization ensues in all the tis- 
sues. The pain may continue during all 
these changes, or it may subside at an earlier 
period. 

The only known remedy for this disease is 
the early performance of what is termed 
iridectomy — an excision of a portion of the 
iris — before the morbid changes have con- 



•96 OUR EYES: 

tinued long enough to crush out the visual 
power, and spoil the eye by their fatal press- 
ure. 

The results of this operation, the greatest 
triumph of modern ophthalmic surgery, seem 
almost miraculous. It at the same time re- 
moves the extreme tension, and puts an end 
to the unhealthy action which gave rise to 
it ; and a sufferer, one or. both of whose eyes 
had become blind, obtains instant relief from 
the intense pain, and regains more or less 
quickly his lost vision. But, to be complete, 
the relief must be speedy : too long compres- 
sion of the delicate tissue of the retina de- 
stroys its powers. 

AMAUROSIS. 

Prior to the invention of the ophthalmo- 
scope, the term " amaurosis " was applied to 
loss of sight arising from sundry obscure con- 
ditions of the deeper-seated parts of the eye. 
Most of these are now distinguished as re- 
sulting from various changes, and are des- 



HOW TO TAKE CxlRE OF TIIEM. 97 

ignated according to the structures affected ; 
and, as now understood, amaurosis implies 
disease in or behind the optic nerve, exclud- 
ing such loss of sight as results from inflam- 
mation of the choroid or retina, separation 
of the retina, &c. Many cases, formerly 
considered hopeless amaurotic disease, are 
now found by the ophthalmoscope to belong 
to a more hopeful class of affections, capable 
of relief. 

DISEASES OF OTHER ORGANS MANIFESTED IN 
THE EYE. 

Not the least among the wonders revealed 
by the ophthalmoscope is the detection of 
diseases of other and distant organs by an 
examination of the internal parts of the eye. 
This has become possible ; and the appear- 
ances indicating degeneration of the kidney 
can be as positively distinguished from those 
denoting certain changes in the brain, or 
from the structural alterations caused by dis- 
eases originating in the eye itself, as any of 

7 



98 OUR EYES: 

the most evident external manifestations of 
disease — as, for instance, those of small-pox 
and scarlatina — can be discriminated from 
each other. The knowledge thus obtained 
will doubtless become more and more avail- 
able in the explanation of phenomena which 
have hitherto been obscure, and aid in the 
successful treatment of disease. 

CATARACT. 

Cataract consists in a loss of transparency 
in the crystalline lens or its capsule. Cloudi- 
ness of the cornea, the result of ulceration, 
is quite a different thing ; though such opaci- 
ties are often supposed to be cataract. 

When children are born with cataract, or 
it is developed early in life, as also in cases 
where it has resulted from a blow or wound 
of the eye, the cataract is usually soft, and 
of a whitish or bluish-white color. When 
caused by a hurt, it is formed only in the in- 
jured eye ; but, when not the result of an ac- 
cident, it generally appears sooner or later in 
both eyes. 



HOW TO TAKE CARE OF THEM. 99 

Soft cataract may be removed with little 
risk by an operation ; but it is safer, in 
many instances, to operate by such a method 
as will require considerable time for the sub- 
sequent absorption and disappearance of the 
opaque lens, rather than to attempt its imme- 
diate removal. 

The larger number of cataracts are found 
in persons beyond middle life ; the disease 
affecting those of every condition and occu- 
pation, without apparent relation to the 
amount or nature of the use they may have 
made of their eyes. It is probably a result 
of modifications in the nutrition of the lens, 
causing it to become opaque, just as the hair 
becomes white in some persons with advan- 
cing age. Like these changes in the hair, it 
is often hereditary. 

The progress of the cloudiness, which 
gradually shuts out perception of objects, 
varies greatly in different cases. This cir- 
cumstance, and the fact that the vision may 
often be temporarily improved by palliatives, 



100 OUR EYES: 

has allowed charlatans to claim that they 
have cured cataract without operation; but 
this pretension, often made, is as often falsi- 
fied by the steady increase of the abnormal 
changes. 

Sometimes the existence of cataract is ac- 
cidentally discovered upon closing one eye, 
when it is found that vision in the other is 
nearly gone. In other instances, a slight 
confusion of vision attracts attention to the 
eye in the very early stages of cloudiness. 

Persons affected with cataract often see 
better in a dim light, at twilight, or on 
cloudy days, and perhaps find themselves 
suddenly unable to see on going into a bright 
sunlight. They should therefore be careful, 
when coming out of church or other places 
into a broad daylight, not to make mistakes 
in their judgment of distances, and thus be 
liable to falls. 

It is an error to suppose that there is no 
help for old people who become blind from 
cataract. The operation for its extraction 



HOW TO TAKE CARE OF THEM. 101 

from tlie eye is generally successful in restor- 
ing vision, — far more so than could have been 
expected, considering the exceeding delicacy 
of structure of the eye ; and it can be done 
without pain, and usually involves only a brief 
confinement. Persons who are in their usual 
health, however aged they may be, whose 
eyes are not otherwise diseased, may therefore 
submit to an operation with confidence and 
hope. 

NATURAL AND ARTIFICIAL LIGHT. 

Of all the requisites for a comfortable use of 
the eyes, none is more important than a favor- 
able and sufficient light ; and perhaps none is 
oftener neglected. Many persons read while 
lying down ; giving more thought to comfort 
in the position of their bodies than to whether 
the light falls in such a direction as is adapt- 
ed for easy vision. Many schoolrooms are so 
arranged as to favor only the teacher, whose 
desk is between the windows ; while a flood 
of light falls full on the faces of the pupils, 



102 OUR EYES: 

whose eyes have no protection against the 
strong glare. 

Such a position as will allow the light to fall 
over the shoulder upon the book or paper is 
best in reading or writing, especially in the 
evening ; the book being also so held that the 
eyes are not exposed to a direct reflection from 
the pages. 

When artificial light is used, it should be 
steady and abundant. Far more harm is done 
by too little than by too much light, when 
the eyes are used for reading, sewing, and 
similar avocations ; and we may well rejoice 
in the advent of better means of illumination 
than were possessed by our ancestors. Tradi- 
tion tells us that tallow-candles and pitch-pine 
splinters enlightened the eager youthful stu- 
dies of some whom our country has ranked 
high among her honored names ; but we are 
more fortunate in having for our " midnight 
oil " the German student's-lamp, the bright 
gas-jet, or the clear flame of kerosene. 

A soft, steady light, such as is given by a 



'■'nOW TO TAKE CARE OF THEM. 103 

student's or a carcel lamp, is perhaps the per- 
fection of artificial light ; yet we may regard 
gas or kerosene as good enough for all practi- 
cal purposes, if used in sufficient quantity, 
and with burners which do not flicker. 



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